1. Sustainable Development and Public Health Helmut Brand Professor of European Public Health helmut.brand@inthealth.unimaas.nl

2. Gro Harlem Brundtland, MD, MPH 74-79 Minister of the Environment of Norway 81 Prime Minister of Norway 87 Our common future (Brundtland Report) 86-89, 90-96 Prime Minister of Norway 98-03 Director General WHO Photo: Harry Wad

3. Concepts for Sustainable Development and Public Health

6. Health sustainability challenges of 21st century societies: 1. Demographic and financial pressure through the ageing of societies 2. New epidemiological developments: increase in overweight and obesity, increase in mental health problems 3. Health system organisation and financing: from acute care to prevention 4. New and re-emerging infectious disaeses: SARS, HIV, Tb 5. Health inequalities 6. Health impact of global warming and climate change: interdependence of health sustainability and environmental sustainability Kickbusch I. Policy Innovations for Health, Springer, 2009, p. 9

7. Obesity

8. 1998 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2007 (*BMI 30, or about 30 lbs. overweight for 54 person) 2007 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% 30% CDC 2009

9. The challenge of obesity in the WHO European Region and the strategies for response, WHO 2007

10. ? Data from Northrhine Westphalia, Germany Obesity at school entry

11. Data from Northrhine Westphalia, Germany lowmedium highEducational level of parents total Obesity at school entry

12. Inequalities

13. Between groups of countries WHO HFA Database

14. In groups of countries WHO HFA Database

15. Between groups in a country

16. Between groups in a city

17. Pandemics

20. Demographic Change

24. the ratio is the number of elderly persons aged 65 and over divided by the number of persons aged 15 to 64

26. Medicalisation or Compression of morbidity ?

29. Climate Change

30. Legend 0.00 - 0.12 0.12 - 0.18 0.18 - 0.27 0.27 - 0.41 0.41 - 0.62 0.62 - 0.78 0.78 - 0.85 0.85 - 0.91 0.91 - 0.97 0.97 - 1.04 1.04 - 1.10 1.10 - 1.16 1.16 - 1.23 1.23 - 1.27 1.27 - 1.31 1.31 - 1.35 1.35 - 1.39 1.39 - 1.59 1.59 - 1.88 1.88 - 2.32 2.32 - 2.99 2.99 - 3.98 3.98 - 5.47 5.47 - 7.70 7.70 - 11.05 Death Frequency on the 12th of August 2003 in comparison to expected values (yearly averages 1998-2002) Robine JM, Cheung SL, Le Roy S, Van Oyen H, Griffiths C, Michel JP, Herrmann FR. The 2003 Heat Wave Project 70.000 excess deaths in 2003

31. Temperature 1% increase in temperature = 1-4% increase in mortality Foodborne infections Vector borne diseases Ultraviolett radiation Skin cancer Malignant melanoma Cataracts Water Flodding Faecal bacteria Hygienic problems Air Ozone Allergic disorders (hay fever, asthma) Increased migration Intra country migration Humanitarian assistance Displaced populations from non EU Member States Vulnerable groups Socio economic gradient Elderly Children Mental disaeses following disaster experience A good overview in: COMMISSION STAFF WORKING DOCUMENT, Accompanying document to the WHITE PAPER Adapting to climate change: Towards a European framework for action. COM(2009)147 final Health Impacts of Climate Change

32. Health Systems

33. WHO European Ministerial Conference on Health Systems: Health Systems, Health and Wealth. Tallinn, Estonia, 25-27 June 2008.

34. The contribution of regions to health and wealth Technical report for the WHO European Ministerial Conference on Health Systems: Health Systems, Health and Wealth, Tallinn, Estonia, 25–27 June 2008 www.euro.who.int/Document/E91414.pdf

35. Prescription: Apply three times a day in case of financial crises !!

36. Health and wealth are interdependent. HEALTH OUTPUT Labour productivity Labour supply Education Savings From: Bloom DE, Canning D. The health and wealth of nations.

37. WHO 2007

38. Health Expenditure as % of GDP OECD 2009

39. EU Health Strategy White paper on Nutrition Communication on Alcohol Tobacco control strategy Health information and Health Portal Project HLS-EU ECDC Interactions with WHO Health Services Initiative Project EUREGIO II Health investments through Structural Funds etc Project Euregio II/III E-Health Public Health Genomics Cross-sectoral work EC 2007

40. Sustainable Development and Public Health Helmut Brand Professor of European Public Health Faculty of Health, Medicine and Life Sciences Maastricht University, The Netherlands helmut.brand@inthealth.unimaas.nl